Pathology of the urinary tract and kidney Flashcards
- A. Cortex
- B. Medulla/Pyramid
- C. Pelvis
4 arrows
What does this show?
Bowmans capsule
What does this show?
Longitudinal sections of distal tubules and loops of Henle
What is renal function impairment?
- Decreased ability of the kidney to excrete nitrogenous waste and regulation of water and electrolytes
- Acute renal function impairment
- Chronic kidney disease ( CKD) - stages 1- 4 based on the GFR
What do U&E include?
- Urea
- Creatinine
- Na+
- K+
- Cl-
- Estimated glomerular filtration rate (eGFR)
A. Which two excretory compounds are raised in renal failure?
B. What test will be abnormal when assessing full blood count in chronic renal failure and why?
A. Which two excretory compounds are raised in renal failure? Urea and creatinine
B. What test will be abnormal when assessing full blood count in chronic renal failure and why?
Low haemoglobin due lack of erythropoietin resulting
in normocytic normochromic anaemia
What are the causes of acute renal failure?
»Hypovolaemic shock due to:
»Bleeding from trauma or GIT e.g. varices/ulcers
»Bleeding from a ruptured aortic aneurysm
»Post partum haemorrhage
»Severe burns; diarrhoea and vomiting
»Septic shock due vasodilatation
»Drugs e.g. gentamycin
»Congestive cardiac failure
What are the causes of chronic renal failure?
»Several types of glomerulonephritis
»Chronic use of some drugs such as aspirin
»Chronic pyelonephritis
»Hypertension and diabetes mellitus
»Autoimmune diseases e.g. SLE
»Obstruction of the urinary tract
What does this show?
In some cases of renal failure the glomeruli are scarred ( glomerulosclerosis – thin arrows) and there is associated chronic inflammation – thick arrows
What are the causes of urinary tract obstruction?
- Calculi or stones
- Stricture in the ureter
- Stricture in the urethra
- Benign prostatic hyperplasia (BPH)
- Cancer of the bladder or prostate
What was the cause of renal failure is this patient?
Renal stones or calculi;
This is termed stag horn calculus.
The kidney is scarred with loss of the cortico-medullary distinction
39 year old man: Haematuria. Weight loss 3 stone. Left loin pain. Raised CRP/ESR/platelets. Abnormal LFTs. Left renal malignancy?
Staghorn calculi with obstruction and severe pyelonephritis abscess formation.
With renal stones always assess calcium levels
- A 51-year-old woman had an incidental finding of abnormal left kidney during investigations for a fibroid uterus for which she underwent hysterectomy
- The CT scan on the next slide shows the left kidney abnormality. What is the diagnosis?
- Her renal function tests were normal.
Why ?
- A 51-year-old woman had an incidental finding of abnormal left kidney during investigations for a fibroid uterus for which she underwent hysterectomy
- The CT scan on the next slide shows the left kidney abnormality. What is the diagnosis? Cystic/dilated kidney due to hydronephrosis
- Her renal function tests were normal.
Why ? Because the right kidney was still functional
What does this show?
What does this show?
Case Report: The histology showed glomerulosclerosis and chronic inflammation
What was the cause of renal failure in this patient?
Autosomal dominant hereditary polycystic kidney – also cysts in the liver and pancreas; not related to polycystic ovaries
What is the common presentation of renal cancer?
- Patients may present with haematuria
- Or as an incidental finding
- Patient may have loin discomfort
- Affects patients in the 60-70 age group
- M>F
patient presented with haematuria
What does this show?
What is Urothelium /transitional cell epithelium?
- Consist of four cells or more
- Acts as a barrier and prevents back diffusion of urine
- Different from squamous epithelium as the cells are more cuboidal than flat
Where does urothelium line?
–Bladder
–Ureters
–Pelvi-calyceal system
What does this show?
Normal urothelium
What does this show?
Bladder mucosa showing chronic inflammation/cystitis.
What are the symptoms of cystitis?
- Dysuria - pain when passing urine
- Haematuria - blood in the urine
- Frequency - passing urine at short intervals
- Urgency - ‘ get out of my way - if I can’t get to the loo soon I will wee on myself!’
- Urge incontinence
+/- fever and lower abdominal pain
What is the common presentation for bladder cancer?
•Patients may present with frank haematuria ( bright red urine in the loo as opposed to microscopic haematuria detected on dipstix)
What are the investigations for bladder cancer?
- Ultra sound scan
- Cystoscopy and biopsy or resection of cancer
- MRI to assess for local spread and lymph node status
- CT Scan – For staging to look for metastasis to other organs
- Histology: transitional cell carcinoma/urothelial carcinoma
What does this show?
Ultrasound scan of a patient who presented with haematuria
Ultrasound scan of a patient who presented with haematuria showing a luminal tumour
What does this show?
Bladder Cancer: Cystoscopy shows a tumour protruding into the lumen; compare with USS
What are these?
The bladder cancer was removed by trans-urethral resection a procedure known as: Transurethral Resection of Bladder Tumour (TRUBT)
What does this show?
Cystectomy specimen with advanced bladder cancer causing bladder outlet obstruction; these days patients would receive neo- adjuvant chemotherapy prior to surgery
What is Benign Prostatic Hyperplasia (BPH)?
- Cause unknown – may be related to androgens
- Affects over 50% of men over 60 years
What are the symptoms of Benign Prostatic Hyperplasia (BPH)?
- Symptoms due to urethral obstruction
- Frequency in micturition
- Nocturia
- Poor stream
- Difficult in starting & stopping stream ( prostatism)
- Urinary tract infections
- Bladder outlet obstruction can leads to hydronephrosis
What does this show?
Acute urine retention due to enlarged prostate
What is the common presentation for prostate cancer?
- Most common cancer in men
- Patient may present with urinary symptoms
- Or raised Prostatic Specific Antigen (PSA), usually requested by GP
- Is there a screening programme for prostatic cancer?
- What are the three screening programmes for cancer in the UK?
- There is no screening programme for prostatic cancer in the UK. However, patients usually request their GP to have PSA test which can be viewed as screening as the patient is asymptomatic.
- PSA is not very specific for prostatic cancer because it can be raised in the presence of inflammation or exercise.
- The 3 cancer screening programmes in the UK are breast cancer, cervical cancer and bowel cancer.
What are the types of specimens from prostates?
- Needle core biopsies for diagnosis of Ca prostate in patients with raised PSA; biopsies taken per rectum under ultrasound guidance
- Transurethral resection of prostate (AKA prostate chips!) for treatment of benign prostatic hyperplasia (BPH) or palliation in Ca prostate if patient presents with obstructive symptoms
- Radical prostatectomy for early prostatic cancer
How is prostate cancer graded?
Needle core biopsies performed under guidance of trans-rectal ultrasound (TRUS).
Prostate cancer has a complex grading system – Gleason Grade
Histology: Adenocarcinoma
What does this show?
Prostatic ‘Chips’ from Transurethral resection of prostate (TURP)
Radical Prostatectomy Specimen What are the complications of this surgical procedure?
The main complications of radical prostatectomy include:
- Bleeding
- Urinary incontinence;
- Impotence and general sexual dysfunction;
- Urinary tract infections
- Stricture/narrowing of the urethra or bladder neck
What are the investigations for prostate cancer?
- PSA - raised in prostatic cancer and other conditions such as inflammation of the prostate
- Needle core biopsy via transrectal ultrasound scan
- MRI detect cancer and assess for local spread
- CT scan to seek for distant metastasis
- Bone scan because prostate cancer spreads to the bones.
What other cancers spread to the bones?
Lung, breast, thyroid and kidney
What does this show?
Advanced prostatic cancer with bone metastases on bone can ( the black dots)
There are metastases are also in the vertebral bones
What is the possible complication of vertebral bone metastasis?
A possible complication of a vertebral bone metastases is spinal cord compression with resultant lower limb paralysis, urinary and faecal incontinence
